Surgeon General Soft on Science

Published July 18, 2007

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In testimony before Congress last week, former U.S. Surgeon General Richard Carmona said that the Bush administration has an adversarial relationship with science.

"Anything that doesn't fit into the political appointees' ideological, theological or political agenda is often ignored, marginalized or simply buried," Carmona said. "The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science or marginalizing the voice of science for reasons driven by changing political winds."

This is a common criticism of the Bush administration, made most thoroughly in journalist Chris Mooney's 2005 book, "The Republican War on Science." When it comes to issues such as global warming, stem cell research or the teaching of evolution — the argument goes — the White House adopts what you might call a "faith-based" approach to science, not an approach grounded in empiricism.

I'm sympathetic to this charge.

One issue Carmona didn't address is medical marijuana. Last year, the FDA put out a baldly political press release claming that "no sound scientific studies supported medical use of marijuana for treatment in the United States."

This is flatly wrong. A wide-ranging 1999 Institute of Medicine report actually did show medical benefits from smoked marijuana while also finding minimal harmful side effects. The FDA press release was right in one respect: There have been no conclusive studies since. But there's a good reason for that: The federal government won't allow them.

Carmona didn't mention medical marijuana in his list of grievances because Carmona isn't any more interested in actual science on the medical marijuana issue than the Bush administration is. When the New York Times asked him his position on the issue, he gave the odd reply that he was against medical marijuana because, "Smoking is bad for you."

In other interviews, Carmona has said medical marijuana is a "science issue, not a political issue," which would be a great answer had Carmona actually looked at the science during his tenure and not merely at the political landscape.

Of course, merely suggesting that we study the possibility of reforming federal drug policy cost Dr. Jocelyn Elders, one of Carmona's predecessors, her job. So perhaps you can't blame him.

It may, indeed, be a fair point to accuse the Bush administration of politicizing science. But Richard Carmona isn't the person to make it. Carmona's entire term as surgeon general has been marked by embracing every last hobgoblin promoted by the public health movement, generally above and beyond what the science says. Sometimes in spite of it.

Last year, for example, Carmona boldly claimed that America's weight problem was a "terror within," and that the threat posed by obesity would "dwarf 9/11, or any other terrorist event."

Carmona trumpeted claims from the Centers for Disease Control that obesity kills 400,000 Americans each year to support his bizarre and completely out-of-context comparison, despite claims from critics that the 400,000 was exaggerated and flawed by poor methodology.

The CDC later admitted its obesity mortality estimate was off by a factor of 15.

Carmona never has let the facts get in the way of his positions on tobacco, either. While drumming up press coverage for a report his office published on secondhand smoke last year, Carmona implored, "Breathing secondhand smoke for even a short time can damage cells and set the cancer process in motion. Brief exposure can have immediate harmful effects on blood and blood vessels, potentially increasing the risk of a heart attack."

This was consistent with the Office of Surgeon General's longtime crusade against smoking, which of late includes support for comprehensive public smoking bans. But the actual report accompanying Carmona's statement to the press said nothing of the kind.

Anti-smoking activist Dr. Michael Siegel — who worked for two years in the CDC's Office on Smoking and Health — wrote on his Web site, "The Surgeon General's press release distorts the science presented in the report and ends up presenting misleading and inaccurate information to the public."

Anti-tobacco groups, Siegel wrote, "are widely distorting the science to create a more sensational and emotional impact on the public. When this phenomenon goes all the way up to the level of the surgeon general's office, you know you've got a serious scientific integrity problem."

Carmona has adopted an activist, if not necessarily science-based, hard line on other issues, too.

Take the touchy subject of alcohol and pregnancy. In 2005, Carmona revised the official federal government position recommending that pregnant women "limit" the amount they drink, to warning them to abstain from alcohol altogether. But as Carmona's own press release concedes, there's simply no new science to back up that position. There are no studies suggesting that a glass of wine or two per week has any effect on fetal development at all.

The announcement was typical paternalistic public health hype. It overstated the risk, made an overly cautious, superfluous recommendation and then made an unscientific, "for the children"-type appeal to emotion.

A final example is smokeless tobacco. In 2003 testimony before Congress Carmona stated, "There is no significant scientific evidence that suggests smokeless tobacco is a safer alternative to cigarettes." He then called for an outright prohibition on smokeless tobacco products. The remark was so farcically not true, one anti-smoking activist called it "a barefaced lie."

Users of smokeless tobacco — particularly varieties such as the Swedish product "snus" — are up to 10 times less likely to get lung cancer than smokers. But you wouldn't know that from government or public health literature. The British medical research group Bio Med Central reported in 2005 that, "A study of 316 Internet Web sites showed that most government, health advice and advocacy Web sites suggested that smokeless tobacco use is as harmful as cigarette smoking, even though the risk is actually extremely small compared to that from smoking."

In this case, Carmona's political posturing in the face of actual science may well be costing lives. Were smokers told the truth about the significantly lower risks associated with smokeless tobacco, many would perhaps decide to switch, getting the same nicotine kick at only a tenth of the risk.

None of this is really new. The Office of Surgeon General always has been overtly political, a captive of the most hysterical public health activists. Its only real powers are tongue-clucking and finger-wagging, usually about the latest moral panic, lecturing the American public to knock off its bad habits, lest somebody get hurt. Richard Carmona's tenure was no different, which is why it's laughable to hear him lecture someone else about science.

Radley Balko is a senior editor with Reason magazine. He publishes the weblog, TheAgitator.com.

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